Healthcare Provider Details

I. General information

NPI: 1033193032
Provider Name (Legal Business Name): RAYMOND ROBERT CAVANAUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FEDERAL ST SUITE 408
SALEM MA
01970-3860
US

IV. Provider business mailing address

20 LONGVIEW DR
MARBLEHEAD MA
01945-1163
US

V. Phone/Fax

Practice location:
  • Phone: 978-354-5021
  • Fax: 978-354-5026
Mailing address:
  • Phone: 978-764-5807
  • Fax: 978-354-5026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number48602
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: